Bulwark Takes - Inside the Ebola Outbreak That Has Experts Sweating (w/ Dr. Craig Spencer)

Episode Date: May 21, 2026

Jonathan Cohn is joined by Dr. Craig Spencer to break down the growing Ebola outbreak in Central Africa, why global health officials are sounding the alarm, and how Trump-era cuts to public health infrastructure could affect the response. Spencer is an emergency medicine physician and Ebola survivor. During the historic 2014 outbreak, he treated patients and then contracted Ebola himself, became one of the most visible voices during that crisis. Dr. Spencer explains why this outbreak has experts more worried than past Ebola flare-ups, how Ebola actually spreads, and why it is very different from a respiratory virus like COVID.Read more from Jonathan Cohn: https://www.thebulwark.com/p/trump-decimated-our-global-health-network-then-ebola-hit-outbreakText TAKES to 64000 for your 2 free gifts with the purchase of any Pocket Hose Ballistic hose. By Texting 64000, you agree to receive recurring automated marketing messages from Pocket Hose. Message frequency varies and data rates may apply. Text STOP at any time to opt out. Text HELP for additional Information. No purchase required. Terms apply, available at https://PocketHose.com/terms.

Hey, everybody. Welcome back to Bullwork Takes. I am Jonathan Cohn. We are here to talk about this Ebola outbreak. What's going on? Why so many people are worried about it, what the U.S. is doing in response or not doing in response. Our guest today is Craig Spencer. He is an emergency medicine physician. He is also a professor of public health at Brown University. If he looks familiar, if his name sounds familiar, that's because he was in the headlines in 2014. He was part of a Doctors Without Borders. mission to go treat people in Guinea during that year's 2014, big historic West African Ebola outbreak. He came back to the United States, contracted the disease. Thankfully for all of us, he's here, he's survived, he's here to kind of walk us through everything from Ebola 101. What is this disease to looking at what the United States is doing, is not doing, and so on. Dr. Spencer, really thanks. I know everyone wants a piece of you. I'm so glad you are here with us today. Yeah, thanks for making time. I'm looking forward to chatting. Yeah, yeah. So let's start high level here for people just tuning into this Ebola. What is it? Where does it come from? How does it spread?

It's a great question because last night I was talking to my five-year-old in bed and he had heard me on NPR yesterday morning and he was like, Dad, there's this disease. I don't know what it is. Where does it come from? So I had to explain to him, you know, Ebola, bad disease, you know, high mortality. There are multiple different strains of it. So people might be hearing that there's this thing called Bundabud you, hard to spell, hard to say. Yeah, I'd say it one more time. How do you say it? Bundabujo. Bundabujo.

Yeah, exactly. Right. Keep going. Yeah. So, you know, there are multiple different strains. The strain that we're dealing with now kind of looks the same clinically. You know, if you're a provider or you're a patient, it's going to look the same or feel the same. But it's different than the strain that caused a 2014 outbreak.

And different from the strains that primarily cause most operas. It's only the third time that we've seen a bull outbreak from Bundabudja strain. It is a virus that is transmitted. I've been calling it a disease of compassion because it's primarily transmitted between people taking care of other people when they're really sick. So think of a mom taking care of their kid or a family member burying one of their loved ones who recently died or a health care worker that might be taking care of someone and the maximum part of their kind of contagiousness.

We think that the reservoir for this virus is a fruit bat, meaning that the fruit bats can carry this virus. It doesn't get them sick, but maybe if they chew on a piece of fruit that you later eat, or if you come in contact with their droppings, you can be affected. My son told me yesterday that if that's the case, then I probably shouldn't eat any fruit after a bat has eaten it,

and I told them that's probably a good set of life advice, whether you're in Congo or in Colombia. And so, you know, we've known about Ebola outbreaks for 50 years. There have been dozens of them. In reality, there have probably been many, many, many, many more that we just haven't detected because the majority of the time, they end up fizzling out pretty quickly. So this one is getting more.

I mean, we've had a number of outbreaks that did make the news since 2014. This one, I'm definitely to tell you. contacting more concern, as much as I've heard about any of the others. I mean, the others have also generated concern. But what is it about this particular outbreak that has a lot of people alarmed? Who declaring it a WHO, declaring it a crisis

of international attention? What's going on? I was concerned as soon as I saw the announcement on Friday that this was going to be remarkably bad. And I know that as someone that's followed these outbreaks for the past decade, the thing that concerned me the most was that the case numbers

when this was first reported was much bigger than most outbreaks when they end. And so even within the first day of this Ebola outbreak, it had already become one of the top 10 largest ever within the first 24 to 48 hours that had joined the top five.

And right now I think it's probably the third largest Ebola outbreak ever. And again, we didn't know about this last Thursday. That's exactly why within a day we saw the World Health Organization come out and declare a public health emergency of international concern, which is essentially a global call to arms to say, hey, this is bad, there's potential for regional and international spread. We need resources to manage this now, because otherwise this is definitely going to get much worse. We also saw on that first day

cases not just in the Congo, but cases hundreds of kilometers away in Kampala, the capital of Uganda. This is concerning for so many reasons. One, we saw cases that were unrelated. So think about two cases of a disease in a place that don't appear to be connected to each other. That's worrisome because that means they're coming from some source somewhere, maybe multiple different sources. You don't know where that source is. Could it be back in the Congo? Could it be somewhere else? Could it be somewhere in Kampala itself? And so we're now, you know, five, six days in. we don't have that much more clarity on exactly how bad this is. But what I can say with confidence is that case numbers are undoubtedly a lot higher than what is being reported.

And this has almost certainly been going on a lot longer than what was initially thought, which was a case, you know, sometime towards the end of April and the health care worker. Yeah. So let's talk for a second about possible impact in Africa and then we're going to broaden the lens. What are we looking at here without an adequate response? What does this look like in the continent? There was an outbreak of Ebola in 2018 to 2020 in exactly the same area, same region. There were thousands of cases. It was the second largest Ebola outbreak.

It was super complicated, particularly because this is a tough place to work. I've worked in Eastern Congo. Road infrastructure is really, really bad. It can take a whole day to go 50 kilometers. Health infrastructure is incredibly limited. You also have conflict. So M23, other groups. That's like a Rwanda-backed militia.

Yeah, exactly. So there's multiple different groups. We don't need to go back to 1994 and the genocide and the aftermath, but there have been for decades. There's done instability and conflict along the border with Uganda, with Rwanda. And this has created instability in the region for healthcare, but also just on a daily basis for folks that are living there. there are refugee camps. What we have with Ebola is an acute humanitarian crisis on top of a

chronic humanitarian crisis. All of that layered on top of the fact that within the past year, the U.S. and other countries have pulled out a lot of their humanitarian support, including support for places like Eastern Congo. Yeah, yeah. Well, we're going to get to that in a second. Just before we get to that, for Americans watching this, they want to know, do I need to, like, start hiding in my house or whatever. I mean, I've heard most people I've talked to have said they are not at the moment, certainly concerned of this becoming a worldwide pandemic as things stand. What's an appropriate way to think about the level of concern, what should, you know, people be thinking in their personal lives? I think it's important for us all to be concerned. This is definitely going to

get much worse. I don't have a whole host of optimism for how this unfolds in the next couple weeks and in months, quite frankly. Do I think this is going to become the next global pandemic? No. Like Ebola is not an efficient transmitter. Like I said, it's a disease of compassion and that it's the people who care for others that get infected. But what you actually need to prevent and stop transmission is not all that complicated.

Washing your hands, gloves. Ideally, when you're taking care of people, you're in full protective equipment, but even just using gloves, washing hands basic sanitation, can slash the likelihood of transmission pretty high. This is not airborne. This is not a respiratory virus. This requires direct contact. And so I'm not concerned about this, you know,

spreading far afield and causing hundreds or thousands of cases outside of Congo. That being said, I would absolutely not be surprised if we end up hearing about cases, not only a lot more in the region, but also cases in other countries around the continent, in Europe, maybe in the U.S. and in other places, that would not be surprising to me at all. I do want to get to the U.S. response to that. But just before we do that, you are one of the relatively unique experience of having both had Ebola and treated Ebola. Just for people

to understand what it's like to go through this, I mean, what does this disease do to people? And for health care workers, what's it like to try to treat it? I mean, what the disease does, unfortunately, is it kills, you know, half, if not more of the people that it infects for the Zaire. strain, the one that I was infected with, the one that's caused the majority of outbreaks, we have treatments and we have vaccines, those created in the aftermath of the 2014 outbreak. Those don't appear to work well for this strain, the Lindabwego strain, and we don't have vaccines or treatments.

So that means we're going to rely on good clinical care, good public health, end of contact tracing. The disease is pretty horrific and that it goes from kind of a non-specific viral thing, you know, fever, headache, malaise, etc., to diarrhea. vomiting some hemorrhage, so you could have bleeding from your gums. One of the things that we saw that was really, really kind of concerning every time we saw it was hiccups. So people that had hiccups seem to be a pretty high predictor of mortality. And you just, you know, you see folks that maybe in the morning look okay and you come back in the afternoon and they're dead.

It is tough for providers who, you know, you're putting yourself in that position, which is really dangerous and really scary. But on top of that, you're doing everything you can and still, you know, 40 to 50% of the people you're taking care of end up dying, particularly people that are older, kids. And it just is really, really hard to repeatedly fail to do the one thing that you feel like you need to be doing, which is like saving lives. Folks, everyone knows how important sleep can be between work and parenting and everything in between. It got to the point where I realized sleeping was pretty much non-negotiable. I was going a bit crazy.

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So my recollection of 2014, there was a bit of a slow ramp up to figure out what to do. But by the time we were done, we had to do. we had kind of gotten pretty good at addressing this. So in theory, we knew what to do and then subsequent outbreaks. I mean, first of all, am I right about that? We've learned a lot since just from having done this a few times. In an ideal world, what would the response look like? I mean, what should the communities of the world?

You said this was a call to arms to the world. What should the response look like, broadly speaking? What should be saying people, supplies? In an ideal world, if you were in control, what would we be doing? So we learned a lot from the 2014 outbreak. We learned that we needed a more operational WHO and those more flexible and more nimble. We put in place some of those things to make that happen. We recognized that we needed better detection architecture all around the world to pick these

up so early that 2014 outbreak wasn't detected for months after it had been spreading, which is part of the concern pretty similar to what we're seeing now. We learned that we needed sustained investments and they couldn't just surge into a reason when there was a problem and leave. We learned that all the lessons that we'd learned in the past, we had already forgotten and we can't forget them again. And so what do I think we would need here? Look, we're flat-footed.

The U.S. would normally have been very aware of what's going on well before the rest of the world. The CDC said on a press call a couple days ago, I think they said they found out Friday, which is the same day like probably you and I found out. That's concerning, right? The fact that we weren't kind of held close enough to be able to work with the Congolese Ministry of Health, others during this earlier

phases of testing, something that we normally would have been able to do. But because of the cuts we've made over the past year, we don't have those relationships. We're not as close. We're not as trusted. We're not working in collaboration as we have had in the past. What do I think we need to do now? We need to surge people, supplies, resources, support, everything that we can. We need to make sure the airport in GOMA is open. We need to make sure the lab at the U.S. help set up with the CDC three years ago in GOMA is functional and is able to help with the backlog of tests. We need to make sure that we can get in as much personal protective equipment as possible because supplies are remarkably short for many of the providers and clinics of the region. And we also need to recognize that this is going to be really, really tough.

This would have been a tough response in ideal conditions, and the conditions right now are anything but. You have conflict. You have distrust of outsiders. You have a place where healthcare infrastructure is remarkably weak. There are things that we're just not going to be able to patch over in a couple days or a couple weeks. In 2019, I think, one of Doctors Without Borders and Bullet Treatment Centers was burned down because the community didn't trust the organization,

despite the fact that MSF had been in the region. Doctors of the boarders had been working in the region for like decades. And so it just goes to show that this is going to be really, really complicated. It's going to be really, really tough to get this under control, even with a perfect response. And we haven't shown ourselves capable of standing up a perfect response a decade ago. I'm not sure that we're capable of doing that right now. Yeah, now I was listening to a CDC press call yesterday.

This is the second, you know, second consecutive one where they said, hey, we are surging resources, we're acting. State Department put out a statement saying they're acting. Are they, is that not true? Are they not reacting? They are. I've spoken to people. The problem is, is that similar to the lessons we learned in 2014,

we're learning the lesson all over again, that it's really hard to coordinate interagency. It's a U.S. government. Over the past decade, we've put in place multiple structures that have then either been, you know, shuttered, taken apart, or just kind of left to wither, things like our Office of Pandemic Preparedness and Response, the NSC, global health folks at the White House. None of those things do we have in place now.

Those were things that we built up in the aftermath of 2014 to say, hey, it was really tough to coordinate across the U.S. government to get state and defense and Homeland Security and USAID and all these people on the same page. We should have a coordinating mechanism to do that. And we built one, but that has since been taking. taken apart. We also have in the U.S. kind of new, a new approach to how we do global health, which is less support to multilateral organizations like WHO, more bilateral deals with countries, some of which, you know, are causing countries to kind of walk away over concerns about data

sharing. And the problem with that is that we have kind of new infrastructure to do this America first, you know, global health approach. And that's the new trend. They took down USAID. We're getting drawing from these organs. And they're putting in this new, we're going to reach agreements with different countries, bilateral agreements that put America first. Right. Yeah. And I think there are certainly, you know, there are certainly weaknesses of this approach.

I don't think it's all, you know, absolute crazy. There are things that needed to change. You know, I think I think there things certainly could be better. Regardless, anytime you close out something well established and turn to something completely new, there are going to be hiccups in terms of how you coordinate, stand up, make sure that it's working effectively. And I think we're seeing that right now if the U.S. response, the U.S. announced yesterday that they're going to put $13 million into the response,

which might sound like a lot of money, but I think it's an absolute pittance compared to what is needed, particularly when you think about each one of these Tyvec suits that, you know, a provider needs to use one time to go into a bullet treatment center can be, you know, probably 100 bucks, if not more. And so, you know, we're doing this thing where we're trying to catch up to something that we should have been dramatically in front of. I think, you know, the cuts over the last year undoubtedly have played a role here. You know, normally USAID would be helping, you know, coordinate, you know, logistics around the country, testing, making sure PPE was in place, making sure that the countries were standing up surveillance at the airports so that cases didn't get on planes.

And just to be clear, there's no more USAID to do that. That's right. Right. And so in previous outbreaks of Ebola over the past year, you know, countries have had to do what WHO has stepped in to do it. But, you know, we've pulled a big chunk of WHO funding. They're short-staffed due to cuts as well, largely because of the U.S. pullout. And so we're seeing, you know, Ebola on top of hauntavirus, on top of, you know, surging measles cases in the U.S., like the international failures and the abdication of leadership,

how it's impacting the response, but also I think how unprepared we are here at home as we leave a lot of our infrastructure to whether we don't have a permanent CDC director and we haven't for 15 of the last 17 months. We don't have a surgeon general. We don't have anyone in the office of pandemic preparedness and response. We don't have a permanent FDA director now. It's just, yeah, our leadership has been has been hobbled and we're seeing the impact. of that, I think, all too clearly. Yeah, yeah. I want to let you go. I had just a couple real quick things. This travel ban that they announced yesterday, any foreign travelers, any foreigners who have been to those countries, your thoughts? Generally, I think that these are usually more performative than anything. I don't know that they make much of a difference.

You know, obviously this administration has already made it nearly impossible for folks from any of these countries that are affected to get to the U.S. anyways. I don't know the actual impact is going to have. I worry that they're stigmatizing all those other things. I also realize that it's not just this administration if there was, you know, a Biden White House or another white house, like they probably would have done the same thing. We've done this over and over in every single outbreak, particularly of Ebola. I think there's some aspects that help with some things that have fallen away in terms of like CDC's monitoring capacity and funneling over the past year.

But at the end of the day, I don't think this is going to make, it's going to do anything more than performative to make it seem like we're doing something as opposed to surging the real supplies, resources, and people to make sure we're able to manage us on the ground so that we don't have to worry about trying to pick up cases in the air before they get on a cruise ship.

We need to stamp this out exactly where it's at right now. Last question, American watching this, why do I worry about this? This is probably isn't going to affect me directly, I'm not going to probably get Ebola. Why should I care? Because this reveals pretty massive gaps in our ability to respond to not just Ebola, but any other concerning outbreak. Like we've seen over the past couple of weeks that, you know, the cliche is diseases don't respect borders, but they also don't respect planes. They don't respect cruise ships. I think most

Americans, there are a lot of Americans can probably relate to the idea of taking a vacation and getting on a cruise ship. And I think that's probably why Huntervars resonated so much with so many people that even if it wasn't at home, it kind of felt like home. We are rolling the dice. We're rolling the dice with our, you know, pretty slow, the U.S. slow and imperfect response to hunter virus. We're rolling the dice here with Ebola. I don't think this is going to be a massive outbreak in the U.S. by any means. But if you roll the dice so many times, eventually you're going to come up snake eyes and you're going to get bit. And I worry that what we're seeing here is our inability to think about what happens when we roll the dice,

when it comes up snake eyes and what we're going to do about it, because I'm pretty concerned that we don't have the infrastructure needed to be able to respond well. Yeah, well, Dr. Spencer, thank you so much. I'm going to let you get back to your work. And if I'm watching, listening to this, thanks for staying with us here at the bulwark. We're going to keep watching, talking, writing about public health issues.

So I hope you'll think about it. Continue to read us. See you next time.